Table Of ContentSeries Editor David E. Elder, MB, ChB Consultant Pathology
R E A S T
A T H O L O G Y
Melinda E. Sanders
Jean F. Sitnpson
Consultant Pathology
breast
pathology
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Consultant Pathology Series
David E. Elder, MB, ChB
Series Editor
Tumorigenic Melanocytic Proliferations
David E. Elder
Brain Tumors
Richard Prayson, Bette Kleinschmidt-DeMasters, and Mark L. Cohen
Head and Neck Pathology
Leon Barnes, Raja Seethala, and Simion Chiosea
Liver Pathology
Linda Ferrell and Sanjay Kakar
Intraoperative Frozen Sections
Pedram Argani and Ashley Cimino-Mathews
Breast Pathology
Melinda E. Sanders and Jean F. Simpson
Forthcoming Volume in the Series
Superficial Melanocytic Pathology
David E. Elder
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Consultant Pathology
Vo l u m e 6
breast pathology
Melinda E. Sanders, MD
Associate Professor of Pathology
Vanderbilt University Medical Center
Nashville, TN
Jean F. Simpson, MD
President
Breast Pathology Consultants, Inc.
Nashville, TN
Adjunct Professor of Pathology
University of South Alabama
Mobile, AL
New York
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Library of Congress Cataloging-in-Publication Data
Sanders, Melinda E., author.
Breast pathology / Melinda E. Sanders, Jean F. Simpson.
p. ; cm. — (Consultant pathology series ; v. 6)
Includes bibliographical references and index.
ISBN 978-1-936287-68-0 — ISBN 978-1-61705-117-3 (e-book)
I. Simpson, Jean F., author. II. Title. III. Series: Consultant pathology series ; 6.
[DNLM: 1. Breast Neoplasms—physiopathology. 2. Breast Diseases—physiopathology. WP 870]
RG493
618.1’907—dc23
2013047924
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To David Lee Page, mentor and friend
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C o n t e n t s
Series Foreword xi
Foreword xiii
Preface xv
1. Alterations of Enlarged Lobular Units 1
1.1 Enlarged Lobular Unit With Apocrine Change 4
1.2 Columnar Cell Lesions Without Atypia 6
1.3 Columnar Cell Lesions With Atypia 9
1.4 Secretory Change 11
2. Epithelial Proliferative Lesions 13
2.1 Hyperplasia Without Atypia, Usual and Florid Patterns 18
2.2 Usual Hyperplasia Without Atypia, “Gynecomastoid Pattern” 20
2.3 Usual Hyperplasia Without Atypia, Compact Pattern 23
2.4 Papillary Apocrine Change 25
2.5 Usual Hyperplasia With Prominent Myoepithelial Cells 28
2.6 Usual Hyperplasia With Clear Cells 30
2.7 Atypical Ductal Hyperplasia, Cribriform Pattern 32
2.8 Collagenous Spherulosis 35
2.9 Atypical Ductal Hyperplasia, Solid Pattern 39
2.10 Atypical Ductal Hyperplasia, Micropapillary Pattern 41
2.11 Atypical Ductal Hyperplasia With Apocrine Cytology 43
2.12 Hypersecretory Hyperplasia 45
2.13 Atypical Ductal Hyperplasia in a Background of Hypersecretory Hyperplasia 47
2.14 Florid Hyperplasia Involving a Papilloma 49
2.15 Cells of Atypical Lobular Hyperplasia Admixed With Florid Hyperplasia,
Involving an Intraductal Papilloma 51
2.16 Collagenous Spherulosis Involving Micropapillomas 53
2.17 Papilloma Involved by Atypical Ductal Hyperplasia 55
2.18 Nipple Adenoma 57
2.19 Mucocele-Like Lesion 59
2.20 Mucocele-Like Lesion With Atypical Ductal Hyperplasia 61
vii
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viii
CoN T E N T S
3. Ductal Carcinoma In Situ, Special Considerations 63
3.1 Ductal Carcinoma In Situ, Low Grade, Minimal Example 70
3.2 Ductal Carcinoma In Situ, Solid Pattern Mimicking LCIS 72
3.3 Ductal Carcinoma In Situ, With Lobular Cytology 74
3.4 Spindle Cell Pattern Ductal Carcinoma 77
3.5 Ductal Carcinoma In Situ With Florid-Like Pattern 79
3.6 Ductal Carcinoma In Situ With Biphasic Pattern 81
3.7 Apocrine Ductal Carcinoma In Situ 83
3.8 Micropapillary Ductal Carcinoma In Situ 88
3.9 Ductal Carcinoma In Situ Arising in a Background of Hypersecretory Hyperplasia 90
3.10 Ductal Carcinoma In Situ Involving Sclerosing Adenosis 92
3.11 Displaced Epithelial Elements After Biopsy of Ductal Carcinoma In Situ 96
3.12 Invasive Carcinoma Associated With Ductal Carcinoma In Situ 99
3.13 Encysted Noninvasive Papillary Carcinoma 101
3.14 Ductal Carcinoma In Situ Involving a Papilloma With Areas of Pseudoinvasion 103
3.15 Paget’s Disease of the Nipple 106
3.16 Toker Cells 108
3.17 Ductal Carcinoma In Situ With Tall Cell Pattern, Involving Papillomas 109
3.18 Secretory Ductal Carcinoma In Situ 111
3.19 Pagetoid Pattern Ductal Carcinoma In Situ 113
3.20 Radiation Change Mimicking Ductal Carcinoma In Situ 115
4. Lobular Neoplasia 117
4.1 Atypical Lobular Hyperplasia With Involvement of Ducts 121
4.2 Classic Lobular Carcinoma In Situ 124
4.3 Lobular Carcinoma In Situ Involving a Fibroadenoma and an Adjacent Lobular Unit 126
5. Sclerosing and Adenotic Lesions 129
5.1 Nodular Apocrine Sclerosing Adenosis 133
5.2 Sclerosed Adenotic Intraductal Papilloma 135
5.3 Adenomyoepithelioma 139
5.4 Radial Scar 142
5.5 Atypical Lobular Hyperplasia Involving Sclerosing Adenosis Associated With a Radial Scar 144
5.6 Microglandular Adenosis 147
5.7 Atypical Microglandular Adenosis 149
6. Fibroepithelial Lesions 151
6.1 Cellular Fibroadenoma 155
6.2 Atypical Ductal Hyperplasia Involving a Fibroadenoma 157
6.3 Atypical Lobular Hyperplasia Involving a Fibroadenoma 159
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ix
CoN T E N T S
6.4 Benign Phyllodes Tumor 161
6.5 Borderline Phyllodes Tumor 164
6.6 Malignant Phyllodes Tumor 167
6.7 Hamartoma 173
7. Reactive and Benign Stromal Lesions 175
7.1 Pseudoangiomatous Stromal Hyperplasia 179
7.2 Reactive Spindle Cell Nodule 181
7.3 Nodular Fasciitis 184
7.4 Cellular Myofibroblastoma 187
7.5 Epithelioid Myofibroblastoma 189
7.6 Fibromatosis 192
7.7 Sclerosing Lymphocytic Lobulitis 195
8. Special Type Carcinomas 197
8.1 Tubular Carcinoma 204
8.2 Invasive Cribriform Carcinoma 208
8.3 Mucinous Carcinoma 212
8.4 Invasive Lobular Carcinoma 215
8.5 Secretory Carcinoma 222
8.6 Adenoid Cystic Carcinoma 224
8.7 Low Grade Fibromatosis-Like Metaplastic Carcinoma 229
8.8 Low Grade Adenosquamous Carcinoma 233
9. Invasive Carcinomas, Special Considerations 235
9.1 Invasive Micropapillary Features 239
9.2 Retraction Artifact 241
9.3 Invasive Carcinoma With Apocrine Differentiation 243
9.4 Invasive Carcinoma With Medullary Features 245
9.5 Invasive Carcinoma With Neuroendocrine Differentiation 247
9.6 Solid Pattern Invasive Carcinoma Mimicking Ductal Carcinoma In Situ 251
9.7 Lymphovascular Invasion Mimicking Ductal Carcinoma In Situ 253
9.8 Invasive Mammary Carcinoma in a Background of Microglandular Adenosis 255
9.9 Entrapped Squamous Morules Within a Previous Biopsy
Site Reaction 257
10. Sentinel Lymph Nodes 259
10.1 Benign Transport 263
10.2 Isolated Tumor Cell Clusters 265
10.3 Micrometastasis 267
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